Robot‐assisted vs open inferior vena cava thrombectomy: a comparative analysis of perioperative and oncological outcomes

Objectives To compare the perioperative and oncological outcomes between open inferior vena cava (IVC) thrombectomy (OP‐IVCT) and robot‐assisted IVCT (RA‐IVCT) for renal tumours with Mayo levels I–IV IVC thrombi. Patients and Methods We retrospectively evaluated patients who underwent radical nephrectomy with IVCT between January 2006 and December 2023 at a high‐volume centre. The patients were stratified according to the surgical approach (OP‐IVCT vs RA‐IVCT). Primary analysis was performed in the full cohort using multivariable regression models, with surgical approach as a covariate. The key perioperative outcomes, postoperative complications, disease‐free survival (DFS), and overall survival (OS) were evaluated. Propensity score matching (PSM) at a one‐to‐one ratio was performed as a sensitivity analysis. Results Of the 226 patients, 37 underwent OP‐IVCT and 189 underwent RA‐IVCT. In the full‐cohort multivariable analyses, RA‐IVCT was independently associated with lower estimated blood loss (adjusted ratio 0.472, P < 0.001), shorter postoperative hospital stay (adjusted ratio 0.798, P = 0.027), reduced intraoperative transfusion (adjusted odds ratio [OR] 0.065, P = 0.002), and fewer postoperative complications (adjusted OR 0.162, P = 0.007). The operative time and intensive care unit transfer did not differ significantly between the groups. The surgical approach was not independently associated with OS (adjusted hazard ratio [HR] 1.019, P = 0.969) or DFS (adjusted HR 0.782, P = 0.528). After PSM, 37 matched pairs were analysed. The matched analysis confirmed lower estimated blood loss, reduced transfusion requirement, shorter hospital stay, and fewer postoperative complications with RA‐IVCT, whereas OS and DFS remained statistically comparable between the groups. Conclusion RA‐IVCT is a safe and effective alternative to OP‐IVCT for patients with renal tumours and IVC tumour thrombi. No evidence of inferior intermediate‐term oncological outcomes was observed for RA‐IVCT.